In the Literature

Summary of "Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial"

Summary published November 17, 2025

Summary by Jeffrey Huang, MD

British Journal of Anaesthesia | June 2023

Cao SJ, Zhang Y, Zhang YX, Zhao W, Pan LH, Sun XD, Jia Z, Ouyang W, Ye QS, Zhang FX, Guo YQ, Ai YQ, Zhao BJ, Yu JB, Liu ZH, Yin N, Li XY, Ma JH, Li HJ, Wang MR, Sessler DI, Ma D, Wang DX; First Study of Perioperative Organ Protection (SPOP1) investigators. Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial. Br J Anaesth. 2023 Aug;131(2):253-265. doi: 10.1016/j.bja.2023.04.024. Epub 2023 Jun 4. PMID: 37474241.

doi: https://doi.org/10.1016/j.bja.2023.04.024

  • Postoperative delirium is more common among elderly patients and is associated with negative long-term outcomes including longer hospital length-of-stay, lower likelihood to be discharged to home, and overall functional decline.
  • Previous retrospective studies have suggested that propofol-based general anesthetics might be associated with lower rates of postoperative delirium when compared with techniques that rely on volatile anesthetics such as sevoflurane.
  • This multicenter randomized controlled trial was conducted across 14 tertiary hospitals in China and investigated the effects of different anesthetic techniques on postoperative brain outcomes in older adults.
  • The study enrolled patients aged 65 to 90 years old who were undergoing major cancer surgery and who had not received prior radiation therapy or chemotherapy.
  • 1228 patients were randomly assigned to receive either propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalational general anesthesia.
  • The primary outcome was the development of delirium within seven days, defined as at least one episode of delirium as assessed using the Confusion Assessment Method (CAM) and CAM for ICU (CAM-ICU) tools. Cognitive function was further evaluated at 30 days and 3 years after surgery using the modified Telephone Interview for Cognitive Status.
  • Secondary outcomes also included need for ICU admission, hospital length-of-stay, and major complications within the first 30 days postoperatively.
  • Postoperative delirium occurred in 8.4% of patients receiving propofol-based anesthesia compared with 12.4% receiving sevoflurane-based anesthesia (p=0.023), with the greatest difference observed on the first postoperative day (5.4% vs 10.7%).
  • Major complications within 30 days and cognitive function at 30 days were similar between groups. Cognitive performance at 3 years was slightly worse in the propofol group, but the difference was not clinically significant.
  • The authors concluded that delirium is less likely to occur in older patients receiving propofol-based anesthesia compared with those given sevoflurane-based anesthesia during major cancer surgery, and suggest that clinicians consider a propofol-based anesthetic in elderly patients at high risk for delirium.